Anxiety Disorders

Question 1

Anxiety Disorders in Adulthood (Historical Perspective)

Answer 1

Neurosis:
- until 1980, anxiety disorders were classified with dissociative and somatoform disorders
- Freud focused on the difference between objective fears and neurotic anxiety
- modern views: behavioural and cognitive-behavioural + biological factors

Question 2

Anxiety Disorders Etiology (Biological Factors)

Answer 2

Genetics:
- heritability range from 30-50%
- broad dispositional/temperamental traits (high neuroticism, behavioural inhibition)

Neuroanatomy and neurotransmitters:
- neural fear circuit: thalamus -> amygdala, areas of the hypothalamus via the mid-brain to the brain stem -> spinal cord
- GABA (inhibitory NT), norepinephrine and serotonin play a role

Question 3

Anxiety Disorders Etiology (Psychosocial Factors: Behavioural)

Answer 3

• anxiety and fear are acquired through learning
• the two-factor model proposes that fears are acquired through classical conditioning but are maintained by operant conditioning (fears are sometimes acquired in the absence of classical conditioning)

Question 4

Anxiety Disorders Etiology (Psychological Factors: Cognitive)

Answer 4

• emotions are influenced by the way people appraise the future, themselves, and the world:
• beliefs - helpless, vulnerable
• schemas
• information processing biases
• automatic thoughts

Question 5

Anxiety Disorders Etiology (Psychological Factors: Interpersonal)

Answer 5

• parents who are exercising excessive control, fostering beliefs of helplessness, & failing to promote self-efficacy and independence (insecure attachment - anxious ambivalent)

Question 6

Panic Disorder

Answer 6

• recurrent and unexpected panic attacks
• persistent concerns about the consequences or meaning of the attack or result in a significant change in behaviour to prevent panic-like sensations

Question 7

Panic Attack DSM-5 Classification

Answer 7

• periods of intense fear or discomfort accompanied by at least four of 13 symptoms:
  1. Palpitations, pounding heart, or accelerated heart rate
  2. Sweating
  3. Trembling or shaking
  4. Sensations of shortness of breath or smothering
  5. Feelings of choking
  6. Chest pain or discomfort
  7. Nausea or abdominal distress
  8. Feeling, dizzy, unsteady, light-headed, or faint
  9. Chills or heat sensations
  10. Parenthesis (numbness or tingling sensations)
  11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  12. Fear of losing control or ‘going crazy/
  13. Fear of dying

Question 8

Agoraphobia

Answer 8

• an active, persistent avoidance of situations
• the person is concerned that he/she will not be able to escape or get help in the event of a panic attack, or other incapacitating or embarrassing symptoms (persist for 6 months or more for diagnosis)
• panic disorder and agoraphobia are assigned as separate diagnoses (they can be co-morbid or exist on their own)

Question 9

Panic Disorder Etiology - A Cognitive Perspective

Answer 9

Alarm Theory:
- System can be activated by emotional cues, creating false alarms, and triggering panic attacks in neutral situations where there is an absence of threat
- small change in the body as ‘signal’

*Panic self-efficacy = perceived ability to cope with panic attacks, important mechanism in CBT

Question 10

Panic Disorder (Diagnosis and Assessment)

Answer 10

Panic disorder vs other anxiety disorder:
- uncued/unexpected panic attacks VS in response to a specific situation
A multi-method assessment includes:
- interviews
- behavioural assessment called a behavioural avoidance test
- symptom induction test

Question 11

Specific Phobia DSM-5 Criteria

Answer 11

• Marked and persistent fear and avoidance of a specific object or situation (e.g., animals, heights)
• Excessive and disproportionate fear
• Must interfere significantly with the person’s life

Five sub-types:
1. Animal phobia
2. Natural environment phobia
3. Blood-injection-injury phobia
4. Situational phobia
5. Other

Question 12

Specific Phobia Etiology

Answer 12

Associative model:
- criticism: equipotentiality premise

Non-associative model:
- biological predisposition for acquiring certain phobias
- failure to habituate + genetic vulnerability to anxiety = specific phobias

• Disgust sensitivity (e.g. spiders, rodents)

Question 13

Social Anxiety Disorder (SocAD) Description

Answer 13

• shyness vs. SocAD
• interpersonal disorder
• intensely afraid of social or performance situations
• fear of showing signs of anxiety or worry that they will behave in a socially inept manner
• Onset: late childhood, adolescence
• High co-morbidity (e.g., depression, substance use)

Question 14

SocAD Etiology (Genetic + Biological Factors)

Answer 14

Genetic Factors:
- ~50%
- behavioural inhibition
- brain structures involved in fear recognition and conditioning (e.g., amygdala)
- anxious arousal and stress
- monitoring of negative affect
- dysregulation of serotonin, norepinephrine, and other neurotransmission systems during stress responses are likely associated with socially anxious behaviour

Question 15

SocAD Etiology (Environmental Factors)

Answer 15

Environmental factors:
- being victimized (bullying, teasing) during childhood
- linked to dysregulation HPA-axis
- intrusive and overprotective parents

Question 16

SocAD Etiology (Cognitive Factors)

Answer 16

• self-focused attention: highly-self-critical
• public self-consciousness
• dishonest self-disclosure: less authentic manner in interactions with others

Question 17

Generalized Anxiety Disorder (GAD) DSM-5 Criteria

Answer 17

Chronic, excessive and uncontrollable worry and anxiety:
3 out of 6 symptoms -
1. Restlessness, feeling on edge
2. Being easily fatigued
3. Difficulty concentrating
4. Irritability
5. Muscle tension
6. Sleep disturbances

Question 18

GAD General Risk Factors & The Role of Cognitions

Answer 18

Verbal aspects of worry dampen:
- uncomfortable anxious arousal

Short-term fix in GAD: Worrying reduce the anxiety symptoms

Intolerance or uncertainty:
- discomfort with ambiguity and uncertainty
- target during treatment

Question 19

Obsessive Compulsive DIsorder (OCD) DSM-5 Criteria

Answer 19

• Obsessions are thoughts or urges that are persistent, unwanted and markedly distressing
• Compulsions are repetitive behaviours (e.g., checking) that a person performs (to reduce anxiety/distress or to prevent a feared outcome)
• Neutralizations are brief behavioural or mental acts that individuals employ in response to an intrusion, to prevent or ‘undo’ the feared situations that appear in their intrusive thought

Obsession & compulsions must be time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Question 20

OCD Two Types of Thought-Action Fusion

Answer 20

1. The belief that “thinking is just as bad as doing it”
   - Ex. thinking about harming another person is just as bad as doing it
2. The belief that having a particular thought about a feared situation will increase the likelihood that the situation will happen
   - Ex. that a family member will die in a car crash

*Though-action fusion is a form of inflated responsibility

Question 21

OCD Etiology (Neurobiological Model)

Answer 21

Neurobiological model:
- Basal ganglia + frontal cortex
- SSRIs- serotonin neurotransmission

Question 22

OCD Etiology (Cognitive-Behavioural Model)

Answer 22

Cognitive-behavioural model:
- Obsessions are causes by the person’s reaction to their own intrusive thoughts
- Catastrophic misinterpretations of these thoughts
- Unhelpful efforts to control the intrusions (e.g. thought suppression)

Question 23

OCD and Checking

Answer 23

• Poor memory?
• Low confidence in their memory
• Repeated checking lowers memory confidence, intensifies doubts and sustains repeated checking

Question 24

Posttraumatic Stress Disorder (PTSD) DSM-5 Symptoms

Answer 24

Non-recovery in response to an event that threatened one’s life or bodily integrity

Symptoms:
- recurrent re-experiencing of the traumatic event (e.g., nightmares)
- persistent emotional or physiological arousal in response to reminders of the trauma
- maladaptive changes in thinking patterns (now seeing the world as a dangerous place) and in mood (emotional numbing)
- hyperarousal and hyper-reactivity (e.g., chronic startle, quick to anger)

*Symptoms must persist for at least 1 month

Question 25

PTSD DSM-5 Diagnosis and Assessment

Answer 25

(A) Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) ways
(B) Presence of one (or more) of intrusion symptoms associated with the traumatic event, beginning after the traumatic event occurred
(C) Persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occurred
(D) Negative alterations in cognitions and mood associated with the traumatic event
(E) Marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event occurred

Question 26

PTSD Etiology (Pre-Event Risk Factors)

Answer 26

Pre-event risk factors:
- low socio-economic status, lower education and lower tested intelligence, and a childhood history of abuse

Question 27

PTSD Etiology (Post-Event Risk Factors)

Answer 27

Post-event risk factors:
- severity of triggering event
- lack of social support
- presence of stressful experiences after the traumatic event

Question 28

PTSD Etiology (Biological)

Answer 28

Abnormalities in brain volume (e.g., the hippocampus) and endocrine function (e.g., the stress hormone cortisol) - Pre or post-trauma?